Abstract
This letter to the editor aims to prompt medical students, residents, and sleep medicine fellows to actively support the implementation of delayed school start times in middle and high schools, considering the significant impact it holds for children and adolescents. During puberty, research has demonstrated that circadian changes result in a sleep-phase delay among adolescents, leading them to sleep and wake up later compared to other age groups. This, coupled with early school start times, contributes to sleep deprivation within this patient population, increasing the likelihood of drowsy driving accidents, mental health problems, academic underperformance, and a predisposition to chronic illnesses like diabetes mellitus and hypertension. As medical students, residents, and fellows in the field of sleep, we must prioritize advocating for healthy sleep and addressing the issue of early school start times. By doing so, we can safeguard the future of medicine and society, ensuring the well-being and success of our middle and high school students.
Citation:
Hernandez VK. To the editor: early school start times in middle and high schools have profound implications for children and teens. J Clin Sleep Med. 2024;20(4):671–672.
Keywords: early school start times; adolescents; healthy sleep; circadian changes; safety, academic performance
Early school start times in middle and high schools have profound implications for children and teens. The issue of school start times is of particular importance to aspiring sleep medicine physicians. As emerging leaders in the field, it is incumbent upon us to utilize our voices as conduits for championing healthy sleep, which in turn fosters enhanced academic performance, public and road safety, and preventive health measures in the next generation. Ninety-three percent of high schools and 83% of middle schools in the United States start before 8:30 am.1,2 The 2023 survey conducted by the American Academy of Sleep Medicine showed that more than 50% of parents in the United States believe that their children are not getting enough sleep. Homework and early school hours were identified by 90% of parents as major barriers to sleep.1,2
Adolescents need 8 to 10 hours of sleep daily.3 Carskadon et al discovered that circadian changes during puberty cause a “sleep-phase delay” in adolescents, making them sleep and wake up later than other age groups. Further research has confirmed these findings while examining the impact of school start times on teenagers’ sleep needs and patterns. A “phase shift” in melatonin release at puberty contributes to this altered sleep-wake cycle.4 Most teens struggle to fall asleep before 11 pm and wake up before 8 am, consequently sleeping less than the 10 hours recommended, and attend school sleep-deprived.5,6
The H.Res.1103 resolution highlighted that inadequate sleep increased the risk for accidents and injuries, hypertension, obesity, diabetes, and depression. The American Automobile Association Foundation for Traffic Safety reported that drowsy driving causes an average of 328,000 motor vehicle accidents in the United States annually, and drivers ages 16 to 24 were 80% more likely to be in a drowsy driving accident compared to adults age 40 or older. Insufficient sleep has also been linked to self-harm, suicidal thoughts, and suicidal attempts. Moreover, 25% of children experience delayed sleep-wake phase disorder, insomnia, obstructive sleep apnea, and restless legs syndrome during childhood.
The American Academy of Pediatrics, the American Medical Association, and the American Academy of Sleep Medicine suggest middle and high school start times be 8:30 am or later to promote health sleep.3 This is because healthy sleep is crucial in achieving the Department of Education’s mission of promoting student achievement and preparing them for global competition through educational excellence and equal access.2 We residents, medical students, and fellows need to actively participate in health policy and advocacy initiatives through organized medicine and influence the development and amendment of laws that prioritize the well-being of our patients’ sleep. The current early start times of middle and high schools pose significant health, safety, and academic performance risks to students. What are we going to do about this? The introduction of legislation such as the “ZZZ’s to A’s Act” and the CS/HB 733 bills are crucial steps toward addressing this issue and need your support to be universally implemented.
DISCLOSURE STATEMENT
The author reports no conflicts of interest.
REFERENCES
- 1. American Academy of Sleep Medicine . AASM Sleep Prioritization Survey: Children and Teen Sleep Disruptors. https://aasm.org/wp-content/uploads/2023/08/sleep-prioritization-survey-2023-sleep-disruptors.pdf . Accessed October 24, 2023.
- 2. H.R . 8787—ZZZ’s to A’s Act. 117th Congress (2021-2022). https://www.congress.gov/bill/117th-congress/house-bill/8787/text/ih?overview=closed&format=txt . Accessed October 26, 2023.
- 3. H.Res.1103 . Expressing support for the designation of the third week of September as National Student Sleep Health Week 116th Congress (2019-2020). https://www.congress.gov/bill/116th-congress/house-resolution/1103/text?format=txt . Accessed October 24, 2023.
- 4. McGeorge D . Sleepless in America: school start times . Educ Health. 2012. ; 30 ( 3 ): 56 – 58 . [Google Scholar]
- 5. Watson NF , Martin JL , Wise MS , et al. American Academy of Sleep Medicine Board of Directors . Delaying middle school and high school start times promotes student health and performance: an American Academy of Sleep Medicine position statement . J Clin Sleep Med. 2017. ; 13 ( 4 ): 623 – 625 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. CS/HB 733—Middle School and High School Start Times by Education and Employment Committee and Rep. Temple and Others (SB 1112 by Senators Burgess and Jones). https://www.flsenate.gov/Committees/BillSummaries/2023/html/3139 . Accessed October 28, 2023.